Provider Demographics
NPI:1922003474
Name:DY, PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:DY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 S CAGE BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-5960
Mailing Address - Country:US
Mailing Address - Phone:956-283-8990
Mailing Address - Fax:956-283-8980
Practice Address - Street 1:806 S CAGE BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-5960
Practice Address - Country:US
Practice Address - Phone:956-283-8990
Practice Address - Fax:956-283-8980
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9055208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX107541803Medicaid